Background
Methods
LPEP program sites
Country (2015–16) | India | Nepal | Indonesia | ||
---|---|---|---|---|---|
Sub-national area | Dadra & Nagar Haveli, UT | Jhapa District | Morang District | Parsa District | Sumenep District |
Population | 427,462 | 887,023 | 1,044,071 | 660,249 | 1,059,000 |
Area (km2) | 491 | 1606 | 1855 | 1353 | 1998 |
New cases detection rate (NCDR/100,000) | 99.4 | 20.97 | 19.3 | 16.56 | 43.3 |
Percent new cases of MB leprosy | 26.5 | 60.75 | 49.0 | 41.44 | 76.3 |
Percent new cases with DGII | 1.8 | 2.69 | 1 | NA | 5.5 |
Percent new cases: | |||||
- Females | 57.8 | 46.24 | 44 | 25.22 | 46.2 |
- Children | 23.2 | 3.76 | 8.9 | 5.40 | 6.5 |
Study design
Data collection
Data Collection Method | Type of data and sources | Nature |
---|---|---|
Phase I: National Leprosy Programs | ||
Desk review | Secondary data from scientific papers, archival records and document on national leprosy control programs | Quantitative data on the epidemiology and performance of the programs. Qualitative data on the SOP and policies |
Direct observation | Primary data | Qualitative observations of the activities such as contact tracing, treatment rehabilitation, etc. |
Interviews | Primary data | Qualitative data on explanations of epidemiological trends, routine functioning, challenges and solutions |
Phase II: LPEP Program | ||
Desk review | Secondary data on LPEP service delivery from MIS | Quantitative data on the coverage of services |
Direct observation | Primary data | Qualitative observations of the LPEP activities such as screening, SDR distribution and recording & reporting |
Interviews | Primary data | Qualitative data on LPEP routine functioning, challenges and solutions |
Data analyses
Results
National Leprosy Control Programs
WHO Framework | Themes | NLEP India | NLCP Nepal | NLCP Indonesia |
---|---|---|---|---|
Service Delivery | Coverage (Prevalence) 2014 | 88,833 cases registered and treated (Source: Global leprosy update 2014) | 2382 cases registered and treated (Source: Global leprosy update 2014) | 19,949 cases registered and treated (Source: Global leprosy update 2014) |
Infrastructure | 153,655 Sub Center; 25,308 PHCs; 5396 CHCs (Source: Rural Health Statistics 2015, India) | 208 PHCs; 1559 HPs; 2643 SHP (Source: Annual Report 2013–14, Dept. of Health, Nepal) | 3395 HCs with IPD and 6345 HCs with only OPD (Source: Jumlah Puskesmas 2015, Indonesia) | |
Activities | Case detection is mainly passive with few periodic active outreach | Case detection is mainly passive | Case detection is mainly passive with few periodic active outreach | |
Routine household contact tracing | Routine household contact tracing | Routine household contact tracing; integrated SDR since 2012 in two districts | ||
Suspect identification & their adherence is checked by volunteers (ASHA) at field level | Suspect identification & their adherence is checked by volunteers (FCHV) at field level | Suspect identification & their adherence is checked by paramedical staff (village midwife) | ||
Contact screening by paramedical staff (PMW/ANM) at sub-center | Contact screening by paramedical staff (Leprosy Focal Person) at Health Post | Contact screening by paramedics staff (Leprosy officer) at HC | ||
Confirmation diagnosis by doctor at PHC and higher | Confirmation diagnosis by Leprosy focal person / doctor at Health Post and higher | Confirmation diagnosis by Leprosy officer at HC and doctor at higher level | ||
Process | Refer Fig. 3
| |||
MDT supply (Source: Interviews) | No stock out situation reported at peripheral level | Seldom stock out situation reported for a very short period at peripheral level | A major stock out situation reported in 2016 at peripheral level | |
Health Workforce | Staff | General health care staff. High epidemic PHCs have additional staff | General health care staff | General health care staff |
Leprosy Training | 10,624 Doctors, 24,255 Paramedics and 104,011 volunteers trained on leprosy (Source: NLEP Progress Report 2014–15) | 150 health worker trained on leprosy. (Source: Annual Report 2013–14, Dept. of Health, Nepal) | 120 Doctors, 516 leprosy staff trained on leprosy in 2014 (Source: Subdit Kusta 2014, Indonesia) | |
Information | Indicators | Standard set of indicators as per WHO | Standard set of indicators as per WHO | Standard set of indicators as per WHO |
Data Management | Individual at sub-center level, then aggregated. | Individual at health-post level, then aggregated. General MIS electronic entry at district level but limited leprosy indicators. | Individual at sub-center level, then aggregated | |
Supervision & Monitoring | CLD State Leprosy Office & District Leprosy Officer | CLD, Regional Health Directorate and District Health / Public Health officer | Department of Leprosy & Yaws (central), Provincial Leprosy Office and District Health Office | |
Reporting | Monthly, quarterly and Annually. Bottom-up at all levels | Monthly, quarterly and Annually. Bottom-up at all levels | Monthly, quarterly and Annually. Bottom-up at all levels | |
Innovation | New initiatives | Developed M.w vaccine | NA | NA |
Financing | Budget | NLEP total budget decreased by 9.8% from 2014 to 15 to 2015–16 (Source: MoHFW, Outcome Budget 2014–15 & 2015–16) | NLCP recurrent budget (released) was increased by 58% from 2012 to 13 to 2013–14 (Source: Annual Report Dept. of Health, 2012–13 & 2013–14) | NA |
Funding | CLD and State Leprosy Office | Ministry of Health and Population | Sub-directorate Leprosy & Yaws and District Health Office | |
OOPs in leprosy | No evidence | |||
Periodicity of funds (Source: Interviews) | Sometimes delay in salary disbursement at peripheral level or case reimbursements to ASHA | Sometimes delay in salary disbursement at peripheral level or case reimbursements to FCHV | Mostly on time | |
Governance | National Strategy | Strategy focus on decentralization of leprosy services. For more information, refer Additional file 1
| Strategy focus on disability and rehabilitation. For more information, refer Additional file 1
| Strategy focus on early detection. For more information, refer Additional file 1
|
Organization structure | Fig. 2
| |||
Integration | Integrated into general health system | Integrated into general health system | Integrated into general health system |
LPEP inception and target population
LPEP implementation comparison
WHO Framework | Themes | LPEP Dadra and Nagar Haveli, India | LPEP Morang, Jhapa and Parsa, Nepal | LPEP Sumenep, Indonesia |
---|---|---|---|---|
Service Delivery | Average coverage (2015–16) | SDR coverage is average 22 contacts per index case | SDR coverage is average 23 contacts per index case | SDR coverage is average 33 contacts per index case |
Infrastructure | General health care system | General health care system | General health care system | |
Activities | Line listing of HH, Neighbours and social contacts | Contact tracing of HH and Neighbours | Contact tracing of HH and Neighbours | |
HH, neighbours and school visits by volunteers (ASHA) and paramedics (ANM/PMW) | HH and neighbours visits by volunteers (FCHV) and paramedics (LFP) | Community gathering by village midwife and paramedics (LO) | ||
Individual screening of contacts by paramedics | Individual screening of contacts by paramedics | Self-screening and then re-screening of the suspects by paramedics | ||
SDR distribution immediately after screening | SDR distribution immediately after screening | SDR distribution after 2–3 days of IEC on self-screening | ||
Onsite data collection (paper forms) | Onsite data collection (paper forms) | Onsite data collection (paper forms) | ||
Process | Refer Fig. 4
| Refer Fig. 4
| Refer Fig. 4
| |
SDR supply | Rifampicin is procured by Dept. of Health in al dosages. Syrups available | Rifampicin is procured by Dept. of Health in all dosage. Syrups not available | Rifampicin is procured by Dept. of Health in all dosage. Syrups not available | |
Health Workforce | Staff | General health care staff + LPEP Supervisor (1) and Research assistants (4) | General health care staff, + LPEP Manager (1) and District supervisors (3) | General health care staff + LPEP manager (1) |
Training | LPEP operations and data management training to the staff before inception | LPEP operations and data management training to the staff before inception | LPEP operations and data management training to the staff before inception | |
Information | Indicators | Demographic, Epidemiology, Clinical and coverage indicators | Demographic, Epidemiology, Clinical and coverage indicators | Demographic, Epidemiology, Clinical and coverage indicators |
Data Management | Electronic data entry at district level by RAs in standard database (similar in all countries) | Electronic data entry at district level by SAs in standard database (similar in all countries) | Electronic data entry at district level by DLO in standard database (similar in all countries) | |
Supervision | Filed supervision by LPEP staff (daily bases), National program (periodic), International partners (twice a year) | Filed supervision by LPEP staff (daily bases), National program (periodic), International partners (twice a year) | Filed supervision by LPEP staff (daily bases), National program (periodic), International partners (twice a year) | |
Reporting | Monthly, quarterly and Annually. Bottom-up at all levels | Monthly, quarterly and Annually. Bottom-up at all levels | Monthly, quarterly and Annually. Bottom-up at all levels | |
Innovation | Initiatives | Rifampicin available in syrup for pediatric cases | No initiatives identified | Hand fan with leprosy and self-screening information. |
Financing | Funding | Majorly Govt. funds. NGO funding only for LPEP staff, monitoring and trainings | Majorly Govt. funds. NGO funding only for LPEP staff, monitoring and trainings | Majorly Govt. funds. NGO funding only for LPEP staff, monitoring and trainings |
Funds disbursement | On time disbursement of NGO funds. The government funds disbursement depends on national program’s status | On time disbursement of NGO funds. The government funds disbursement depends on national program’s status | On time disbursement of NGO funds. The government funds disbursement depends on national program’s status | |
Governance | Strategy | Extended contact tracing, including social contacts (school children) | Extended contact tracing | Extended contact tracing with self- screening |
Integration | Integrated into general health system | Integrated into general health system | Integrated into general health system |